Anatomical study of paratenons and fascia lata connections in the posteromedial knee region.

INTRODUCTION: In the last decade, fascia research increased significantly in various aspects such as anatomical and biomechanical features related to epimuscular force transmission. METHODS: The present anatomic study focuses on macroscopic observations of the potential gracilis and semitendinosus paratenons, as well as fascial surroundings connections in the posteromedial knee region on 17 lower-limbs dissections. RESULTS: The gracilis and semitendinosus expansions and paratenons were observed in all specimen and further connections with the fascia lata and crural fascia were demonstrated. Contrary to the previously described expansions connected to the tendons, we observed that the expansions were the edges of the paratenon tunnel and that the paratenon structure surrounded the overall muscle. Both paratenons of gracilis and semitendinosus were connected to the crural fascia and, respectively, to the sartorius fascia (part of the fascia lata), to the semimembranosus and the fascia lata. Furthermore, numerous connections between the fascia lata and the neighboring structures in the posteromedial knee region are described. DISCUSSION-CONCLUSION: The present study describes for the first time gracilis and semitendinosus paratenons and other surrounding fascial connections. Such macroscopic observations may represent a new basis for further characterization of the myofascial pathway of epimuscular force transmission in the knee region.

The biomechanical role of the lacertus fibrosus of the biceps brachii Muscle.

PURPOSE: The lacertus fibrosus (LF) is involved in various surgeries. However, the biomechanical contribution of the LF remains unclear. The aim of this study was to determine the role of the lacertus fibrosus on the elbow and forearm kinematics and on the biceps brachii muscle lever arms. METHODS: This biomechanical study was performed on seven fresh-frozen upper limbs of cadavers. Elbow flexion, forearm supination, and biceps brachii muscle lever arms were analyzed in the intact conditions (I) and after superficial (R) and deep part (R2) of the lacertus fibrosus release, respectively. RESULTS: Elbow flexion shows a significant difference (p < 0.0001) between I, R, R2. Abduction/adduction shows a significant difference between I-R (p < 0.0001) and I-R2 (p < 0.0001). Supination does not show a significant difference in mean maximum amplitude, but between 40 and 70%, there are significant differences. There is a significant mean decrease of lever arm in flexion (28%) and supination (50%) after superficial and deep part of the lacertus fibrosus release. CONCLUSION: The results of this study show that the lacertus fibrosus increases the lever arm during flexion and supination. It limits the flexion and abduction of the elbow and supination of the forearm. Lacertus fibrosus maintains the rhythmicity between the elbow flexion and supination of the forearm. LEVEL OF EVIDENCE: Basic science study, biomechanics.

Reaction Force Magnitude and Orientation During Supine Thoracic Spine Thrust Manipulation: An Exploratory Analysis and Reliability of Preload and Impulse Phase.

OBJECTIVE: The main purpose of this study was to explore specific kinetic parameters during supine thoracic thrust manipulation and to analyze task reliability and differences between various practitioners METHODS: Kinetic parameters were assessed by examining ground reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. The manipulative procedure (consisting of the application of 3 preloads followed by 1 single thrust adjustment) was performed by different practitioners at 3 sessions. Application of thrust was allowed for trained practitioners only. Preload force, peak force, and vector force orientation were compared between sessions and practitioners. RESULTS: Reliability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation data. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase. CONCLUSION: This study is the first that explores kinetic parameters for supine thoracic thrust manipulation. Task repeatability was confirmed and several differences were observed between practitioners. Certainly, there is a need for further investigation examining both dynamic parameters (ie, velocity and accelerations) and the potential neurologic effect of such manipulative technique.

What is the Safest Sprint Starting Position for American Football Players?

The main objective of this study was to perform a biomechanical analysis of three different sprint start patterns to determine the safest position in term of neck injury and Sport-Related Concussion (SRC). The second objective was to collect data on the learning process effect between football players and non-players. Three different sprint initial positions adopted by football players were studied (i.e., 4-, 3- and 2-point positions). Twenty five young healthy males, including 12 football players, participated to this study. A stereophotogrammetric system (i.e., Vicon) was used to record motion patterns and body segments positions. Various measurements related to head and trunk orientation, and player field-of-view were obtained (e.g., head height, trunk bending, time to reach upright position, head speed (vertical direction) and body speed (horizontal direction)). Learning process was found to have no influence on studied parameters. Head redress is also delayed when adopting a 4-point position leading to a reduce field-of-view during the start and increasing therefore the probability of collision. Concerning the three different positions, the 4-point position seems to be the more dangerous because leading to higher kinetic energy than the 2- and 3-point start positions. This study proposes a first biomechanical approach to understand risk/benefit balance for athletes for those three different start positions. Results suggested that the 4-point position is the most risky for football players. Key pointsMotion analysis and biomechanical analysis of the initial start position of the sprint could be used to increase the safety of the football players.Analysis of kinematic and trajectory of the head and the time to reach the upright position could be used to determine whether or not a player can return to play after concussion.A balance needs to be found between player's safety (2-point start) and speed (4-point start).

Measuring the global mechanical properties of the human thorax: Costo-vertebral articulation.

Biomechanical simulation of the human thorax, e.g. for 3D-printed rib implant optimisation, requires an accurate knowledge of the associated articulation and tissue stiffness. The present study is focusing on determining the stiffness of the costo-vertebral articulations. Specimens of rib segments including the adjacent thoracic vertebrae and ligaments were obtained from two human post-mortem bodies at four different rib levels. The rib samples were loaded with a tensile force in the local longitudinal, sagittal and transverse direction and the resulting displacement was continuously measured. The moment-angle response of the rib articulations was also determined by applying a load at the rib end in the cranial - caudal direction and measuring the resulting displacement. The torsional load response of the costo-vertebral articulations at an applied moment between -0.1 Nm and 0.1 Nm corresponded to a median range of motion of 13.2° (6.4° to 20.9°). An almost uniform stiffness was measured in all tensile loading directions. The median displacement at the defined force of 28 N was 1.41 mm in the longitudinal, 1.55 mm in the sagittal, and 1.08 mm in the transverse direction. The measured moment-angle response of the costo-vertebral articulation is in line with the data from literature. On the contrary, larger displacements in longitudinal, sagittal and transverse directions were measured compared to the values found in literature.

Variation in human 3D trunk shape and its functional implications in hominin evolution.

This study investigates the contribution of external trunk morphology and posture to running performance in an evolutionary framework. It has been proposed that the evolution from primitive to derived features of torso shape involved changes from a mediolaterally wider into a narrower, and antero-posteriorly deeper into a shallower, more lightly built external trunk configuration, possibly in relation to habitat-related changes in locomotor and running behaviour. In this context we produced experimental data to address the hypothesis that medio-laterally narrow and antero-posteriorly shallow torso morphologies favour endurance running capacities. We used 3D geometric morphometrics to relate external 3D trunk shape of trained, young male volunteers (N = 27) to variation in running velocities during different workloads determined at 45-50%, 70% and 85% of heart rate reserve (HRR) and maximum velocity. Below 85% HRR no relationship existed between torso shape and running velocity. However, at 85% HRR and, more clearly, at maximum velocity, we found highly statistically significant relations between external torso shape and running performance. Among all trained subjects those with a relatively narrow, flat torso, a small thoracic kyphosis and a more pronounced lumbar lordosis achieved significantly higher running velocities. These results support the hypothesis that external trunk morphology relates to running performance. Low thoracic kyphosis with a flatter ribcage may affect positively respiratory biomechanics, while increased lordosis affects trunk posture and may be beneficial for lower limb biomechanics related to leg return. Assuming that running workload at 45-50% HRR occurs within aerobic metabolism, our results may imply that external torso shape is unrelated to the evolution of endurance running performance.

Measurement of global mechanical properties of human thorax: Costal cartilage.

Surgical resection of chest wall tumours may lead to a loss of ribcage stability and requires reconstruction to allow for physical thorax functioning. When titanium implants are used especially for larger, lateral defects, they tend to break. Implant failures are mainly due to specific mechanical requirements for chest-wall reconstruction which must mimic the physiological properties and which are not yet met by available implants. In order to develop new implants, the mechanical characteristics of ribs, joints and cartilages are investigated. Rib loading is highly dependent on the global thorax kinematics, making implant development substantially challenging. Costal cartilage contributes vastly to the entire thorax load-deformation behaviour, and also to rib loading patterns. Computational models of the thoracic cage require mechanical properties on the global stiffness, to simulate rib kinematics and evaluate stresses in the ribs and costal cartilage. In this study the mechanical stiffness of human costal cartilage is assessed with bending, torsion and tensile tests. The elastic moduli for the bending in four major directions ranged from 2.2 to 60.8 MPa, shear moduli ranged from 5.7 to 24.7 MPa for torsion, and tensile elastic moduli ranging from 5.6 to 29.6 MPa. This article provides mechanical properties for costal cartilage. The results of these measurements are used for the development of a whole thorax finite element model to investigate ribcage biomechanics and subsequently to design improved rib implants.

The evolution, form and function of the human respiratory system.

This paper presents an updated view on the morphological and functional significance of the human respiratory system in the context of human evolutionary anatomy. While usually the respiratory system is treated either from a craniofacial perspective, mostly in the context of nasal evolution and air-conditioning, or from a postcranial perspective featuring on overall thoracic shape changes, here we pursue a holistic perspective on the form, function, integration, and evolutionary change of the entire organismal system in hominins. We first present a brief review of the most important morphological structures, their function, and its potential integration and interaction with the nasal cavity and thoracic skeleton. This is followed by an overview of the most important improvements in methods for the comparative study in recent humans and fossil hominins. We then overview and list a compendium of hominin fossil material currently available for the study. We propose four functional categories of hominin respiratory system configurations that differ potentially with respect to size, shape, biomechanics and/or bioenergetics. Finally, we discuss these and speculate on possible ways for future research into an anatomical system that, despite its under-investigated status, is central to the understanding of the form and functions of the hominin organism and its paleobiology.

Biomechanics of the upper cervical spine ligaments in axial rotation and flexion-extension: Considerations into the clinical framework.

CONTEXT: The motion of the upper cervical spine (UCS) has a great interest for analyzing the biomechanical features of this joint complex, especially in case of instability. Although investigators have analyzed numerous kinematics and musculoskeletal characteristics, there are still little data available regarding several suboccipital ligaments such as occipito-atlantal, atlantoaxial, and cruciform ligaments. OBJECTIVE: The aim of this study is to quantify the length and moment arm magnitudes of suboccipital ligaments and to integrate data into specific 3D-model, including musculoskeletal and motion representation. MATERIALS AND METHODS: Based on a recent method, suboccipital ligaments were identified using UCS anatomical modeling. Biomechanical characteristics of these anatomical structures were assessed for sagittal and transversal displacements regarding length and moment arm alterations. RESULTS: Outcomes data indicated length alterations >25% for occipito-atlantal, atlanto-axial and apical ligaments. The length alteration of unique ligaments was negligible. Length variation was dependent on the motion direction considered. Regarding moment arm, larger magnitudes were observed for posterior ligaments, and consistent alteration was depicted for these structures. CONCLUSION: These outcomes supply relevant biomechanical characteristics of the UCS ligaments in flexion-extension and axial rotation by quantifying length and moment arm magnitude. Moreover, 3D anatomical modeling and motion representation can help in the process of understanding of musculoskeletal behaviors of the craniovertebral junction.

Morphometric analysis of the costal facet of the thoracic vertebrae.

Various studies have examined morphometric features of the vertebrae to understand the functional aspects of the spine. Geometric analysis of vertebral zygapophyseal facets has also been related to functional and clinical aspects of the spine, but no quantitative investigation of the costotransverse joint facet is found in the literature. The costal facet geometry may partly determine the mechanical interaction between the rib cage and spine for trunk stabilization during functional tasks and during breathing. Therefore, the present study proposes a method for estimating the 3D geometric features of the costal facets of the first 10 thoracic vertebrae (Th1-Th10). Series of landmarks (95 ± 43) were placed on 258 costal facets from a sample of 14 asymptomatic individuals to determine their 3D location and orientation. The relative location of the costal facet was used to investigate symmetry and asymmetry components of the overall vertebrae shape variation among thoracic levels using 3D geometric morphometric methods. Results showed significant variation in sagittal orientation (inclination angle) between levels with a gradual cephalic orientation in the lower levels. No significant difference was observed on transverse orientation (declination angle). The shape of the costal facet was flatter at Th1 and from Th5 to Th10 and more concave from Th2 to Th4. An average difference of 7° between right and left facet orientation in both sagittal and transverse plane was demonstrated. Asymmetry of costal facet relative location was also detected and significantly influenced by the thoracic level. Nevertheless, location and orientation of the costal facets seem to be independent features of vertebrae morphology.

Rib cage anatomy in Homo erectus suggests a recent evolutionary origin of modern human body shape.

The tall and narrow body shape of anatomically modern humans (Homo sapiens) evolved via changes in the thorax, pelvis and limbs. It is debated, however, whether these modifications first evolved together in African Homo erectus, or whether H. erectus had a more primitive body shape that was distinct from both the more ape-like Australopithecus species and H. sapiens. Here we present the first quantitative three-dimensional reconstruction of the thorax of the juvenile H. erectus skeleton, KNM-WT 15000, from Nariokotome, Kenya, along with its estimated adult rib cage, for comparison with H. sapiens and the Kebara 2 Neanderthal. Our three-dimensional reconstruction demonstrates a short, mediolaterally wide and anteroposteriorly deep thorax in KNM-WT 15000 that differs considerably from the much shallower thorax of H. sapiens, pointing to a recent evolutionary origin of fully modern human body shape. The large respiratory capacity of KNM-WT 15000 is compatible with the relatively stocky, more primitive, body shape of H. erectus.

Metatarsal arch deformation and forefoot kinematics during gait in asymptomatic subjects.

This study aimed to investigate both foot arch-shaped architecture and forefoot kinematics during gait. Using a dedicated three-compartment forefoot subdivision, we studied asymptomatic subjects and quantified disorders related to the metatarsal arch. Foot motion and arch shape were measured in 30 healthy subjects with a motion-capture system and force plates. Kinematic results were expressed using a novel model, which anatomically divides the forefoot into three parts. This model integrated the medial longitudinal arch angle and the metatarsal arch height and width. During the first part of stance phase, the medial longitudinal arch flattens and all foot segments move toward dorsiflexion. During terminal stance and preswing phase, medial longitudinal and metatarsal arch restoration was noted with plantarflexion of all segments, an eversion and abduction of the medial forefoot, and an inversion and adduction of the lateral forefoot. Kinematics obtained with the proposed forefoot model corroborates metatarsal arch restoration in late stance. This observation supports the fact that foot architecture is supple until midstance and subsequently creates a rigid lever arm with restored arches to support propulsion. This study's results and methods highlight the potential of the three-compartment model for use in clinical decision-making.

Morphometric changes of the cervical intervertebral foramen: A comparative analysis of pre-manipulative positioning and physiological axial rotation.

BACKGROUND: Cervical foraminal impingement has been described as a source of radicular pain. Clinical tests and head motions have been reported for affecting the intervertebral foramen (IVF) dimensions. Although manual approaches are proposed in the management of cervical radiculopathy, their influence on the foraminal dimensions remains unclear. OBJECTIVES: To investigate the influence of pre-manipulative positioning versus cervical axial rotation on the foraminal dimensions of the lower cervical spine. METHODS: Thirty asymptomatic volunteers underwent CT scan imaging in neutral position and axial rotation or pre-manipulative positioning. The manipulation task was performed at C4-C5 following a multiple components procedure. 3D kinematics and IVF (height, width and area) were computed for each cervical segment. RESULTS: The results showed that foraminal changes are dependent on motion types and cervical levels. With reference to head rotation, IVF opening occurred on the ipsilateral side during pre-manipulative positioning while axial rotation involved the contralateral side. Regardless of the side considered, magnitudes of opening were similar between both attitudes while narrowing was lower at the target and adjacent levels during the pre-manipulative positioning. Some associations between segmental motion and IVF changes were observed for the target level and the overlying level. CONCLUSIONS: The present study demonstrated that pre-manipulative positioning targeting C4-C5 modified IVF dimensions differently than the passive axial rotation. The findings suggest that techniques which incorporate combined movement positioning influence segmental motion and IVF dimensions differently at the target segment, compared to unconstrained rotation. Further investigations are needed to determine the clinical outcomes of such an approach.

In-vivo analysis of sternal angle, sternal and sternocostal kinematics in supine humans during breathing.

This paper aims at contributing to the understanding of the combination of in vivo sternum displacement, sternal angle variations and sternocostal joints (SCJ) kinematics of the seven first rib pairs over the inspiratory capacity (IC). Retrospective codified spiral-CT data obtained at total lung capacity (TLC), middle of inspiratory capacity (MIC) and at functional residual capacity (FRC) were used to compute kinematic parameters of the bones and joints of interest in a sample of 12 asymptomatic subjects. 3D models of rib, thoracic vertebra, manubrium and sternum were processed to determine anatomical landmarks (ALs) on each bone. These ALs were used to create local coordinate system and compute spatial transformation of ribs and manubrium relative to sternum, and sternum relative to thoracic vertebra. The rib angular displacements and associated orientation of rotation axes and joint pivot points (JPP), the sternal angle variations and the associated displacement of the sternum relative to vertebra were computed between each breathing pose at the three lung volumes. Results can be summarized as following: (1) sternum cephalic displacement ranged between 17.8 and 19.2mm over the IC; (2) the sternal angle showed a mean variation of 4.4°±2.7° over the IC; (3) ranges of rib rotation relative to sternum decreased gradually with increasing rib level; (4) axes of rotation were similarly oriented at each SCJ; (5) JPP spatial displacements showed less variations at first SCJ compared to levels underneath; (6) linear relation was demonstrated between SCJ ROMs and sternum cephalic displacement over the IC.

How different are the Kebara 2 ribs to modern humans?

This study analyses rib geometric parameters of individual ribs of 14 modern human subjects (7 males and 7 females) in comparison to the reconstructed ribs of the Kebara 2 skeleton which was taken from the reconstruction of a Neandertal thorax by Sawyer & Maley (2005). Three-dimensional (3D) models were segmented from CT scans and each rib vertex cloud was placed into a local coordinate system defined from the rib principal axes. Rib clouds were then analysed using best fitting ellipses of the external contours of the cross-section areas. The centroid of each ellipse was then used to measure the centroidal pathway between each slice (rib midline). Curvature of the ribs was measured from the mid-line of the ribs as the sum of angles between successive centroids in adjacent cross sections. Distinct common patterns were noted in all rib geometric parameters for modern humans. The Kebara 2 reconstructed ribs also followed the same patterns. This study demonstrated that there are differences between the sexes in rib geometrical parameters, with females showing smaller rib width, chord length and arc length, but greater curvature (rib torsion, rib axial curvature, rib anterior-posterior bending) than males. The Kebara 2 reconstructed ribs were within the modern human range for the majority of geometrical parameters.

Assessment of in vivo 3D kinematics of cervical spine manipulation: Influence of practitioner experience and occurrence of cavitation noise.

BACKGROUND: Investigations on 3D kinematics during spinal manipulation are widely reported for assessing motion data, task reliability and clinical effects. However the link between cavitation occurrence and specific kinematics remains questionable. OBJECTIVES: This paper investigates the 3D head-trunk kinematics during high velocity low amplitude (HVLA) manipulation for different practitioners with respect to the occurrence of cavitation. METHODS: Head-trunk 3D motions were sampled during HVLA manipulation in twenty asymptomatic volunteers manipulated by four practitioners with different seniority (years of experience). Four target levels were selected, C3 and C5 on each side, and were randomly allocated to the different practitioners. The data was recorded before, during and after each set of trial in each anatomical plane. The number of trials with cavitation occurrence was collected for each practitioner. RESULTS: The manipulation task was performed using extension, ipsilateral side bending and contra-lateral axial rotation independent of side or target level. The displayed angular motion magnitudes did not exceed normal active ROM. Regardless cavitation occurrence, wide variations were observed between practitioners, especially in terms of velocity and acceleration. Cavitation occurrence was related to several kinematics features (i.e. frontal ROM and velocity, sagittal acceleration) and practitioner experience. In addition, multilevel cavitation was observed regularly. CONCLUSIONS: Kinematics of cervical manipulation is dependent on practitioner and years of experience. Cavitation occurrence could be related to particular kinematics features. These aspects should be further investigated in order to improve teaching and learning of cervical manipulation technique.

Relationship between costovertebral joint kinematics and lung volume in supine humans.

This study investigates the relationship between the motion of the first ten costovertebral joints (CVJ) and lung volume over the inspiratory capacity (IC) using detailed kinematic analysis in a sample of 12 asymptomatic subjects. Retrospective codified spiral-CT data obtained at total lung capacity (TLC), middle of inspiratory capacity (MIC) and at functional residual capacity (FRC) were analysed. CVJ 3D kinematics were processed using previously-published methods. We tested the influence of the side, CVJ level and lung volume on CVJ kinematics. In addition, the correlations between anthropologic/pulmonary variables and CVJ kinematics were analysed. No linear correlation was found between lung volumes and CVJ kinematics. Major findings concerning 3D kinematics can be summarized as follows: 1) Ranges-of-motion decrease gradually with increasing CVJ level; 2) rib displacements are significantly reduced at lung volumes above the MIC and do not differ between CVJ levels; 3) the axes of rotation of the ribs are similarly oriented for all CVJ levels.

3D motion reliability of occipital condylar glide testing: From concept to kinematics evidence.

BACKGROUND: To date, segmental data analyzing kinematics of occipital condylar testing or mobilization is lacking. OBJECTIVES: The objective of this study was to assess occipitoatlantal 3D motion components and to analyze inter- and intra-rater reliability during in vitro condylar glide test. METHODS: To conduct this study, four fresh cadavers were included. Dissection was carried out to ensure technical clusters placement to skull, C1 and C2. During condylar glide test, bone motion data was computed using an optoelectronic system. The reliability of motion kinematics was assessed for three skilled practitioners performing two sessions of 3 trials on two days interval. FINDINGS: During testing, average absolute motion ROM (±SD) were up to 4.1 ± 2.1°, 0.7 ± 1.3° and 10.3 ± 2.5° for occipitoatlantal lateral bending, axial rotation and flexion-extension, respectively. For position variation, magnitudes were 2.3 ± 1.8 mm, 1.1 ± 1.3 mm and 2.6 ± 0.8 mm for anteroposterior, cephalocaudal and mediolateral displacements. Concerning motion reliability, variation ranged from 0.6° to 3.4° and from 0.3 mm to 1.6 mm for angular displacement and condyle position variation, respectively. In general, good to excellent agreement was observed (ICC ranging from 0.728 to 0.978) for the same operator, while consistency was limited to lateral/side bending and lateral condyle displacement between operators, with respective ICCs of 0.800 and 0.955. CONCLUSIONS: This study shows specific motion patterns involving extension and lateral bending of the occipitoatlantal level for anterior condylar glide test. In addition, condyle position variation demonstrated coupled components in forward and heterolateral directions. However, task seems not to be side specific. In general, reliability of 3D motion components showed good intra-operator agreement and limited inter-operator agreement.